# OROURKE AND WONDERLY DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073153979
- **Authorized official:** DR. LORA WONDERLY DDS (DENTIST)
- **Authorized official phone:** (616) 455-7930

## Contact information

- **Practice address:** 4250 KALAMAZOO AVE SE, GRAND RAPIDS, MI 49508-2699
- **Practice address phone:** (616) 455-7930
- **Practice address fax:** (616) 455-9952
- **Mailing address:** 4250 KALAMAZOO AVE SE, GRAND RAPIDS, MI 49508-2699
- **Mailing address phone:** (616) 455-7930
- **Mailing address fax:** (616) 455-9952

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 01/09/2020
- **Last updated:** 01/09/2020